Conclusion

Conclusion

A survey of low- and middle-income countries found that in 2009, among the countries which reported, HIV prevention services reached around 58% of sex workers, 32% of injecting drug users, and 57% of men who have sex with men.⁵⁴ Just 53% of HIV-positive pregnant women received drugs to help prevent their babies becoming infected. Globally, it has been estimated that a condom was used in only 9% of sex acts with a non-marital and non-co-habiting partner in 2005. The global supply of public-sector condoms is less than half of what is needed to ensure adequate condom coverage.⁵⁵

There is no single best approach to HIV prevention; the response must be designed to fit local conditions and the state of the epidemic

As these statistics show, HIV prevention around the world needs much improvement. Progress is slowly being made in some areas, but there is still a very long way to go. As governments and other agencies try to develop better programmes, they would do well to consider some of the examples outlined in this page.

There is no single best approach to HIV prevention; the response must be designed to fit local conditions and the state of the epidemic. Nevertheless, most of the successful programmes – whether in Uganda, Senegal, Thailand, Brazil or among gay men in America – do have at least three features in common.

Firstly, these programmes encourage open communication about AIDS and the activities that put people at risk of infection, while at the same time combating stigma and discrimination. Secondly, they are pragmatic. Rather than just trying to eliminate certain types of sexual behaviour or drug use, they recognise that some people will continue to do these things, and that they should be helped to do so more safely. Thirdly, they involve the affected communities themselves in programme design and implementation. This ensures that the programme is carefully tailored to the communities’ needs, and that it is seen as something done “with them” rather than “to them”. The work of small community-based organisations has been vital to each of these successful programmes.

The only obvious exception is Cuba. However, that country’s system of more or less mandatory testing and quarantine is widely believed to violate human rights, and it would not be feasible in a country where HIV is already widespread.

Last but not least, strong leadership is essential for HIV prevention campaigns to have a far-reaching and sustained impact. This means that politicians, religious leaders and others in authority must become actively involved in the response, and must ensure that it receives adequate resources. If all of the world’s leaders truly committed themselves to this cause then a great many lives would be saved.